1.
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Full Name In Capital Letters
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___________________________________________
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2.
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Designation
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___________________________________________
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3.
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Sponsoring Authority
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a) Circle
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___________________________________________
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b) Division
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___________________________________________
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4.
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Date of Birth
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___________________________________________
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a) Age on the start of Course :
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___________________________________________
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(Required to be less than 55 years for Short Term Course & 50 years for Long
Term Course)
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5.
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Sex
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___________________________________________
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6.
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Address for Communication
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___________________________________________
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(with Pin Code)
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___________________________________________
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Telephone Number
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___________________________________________
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Fax Number
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___________________________________________
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Email
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_____________________________________________
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7.
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Is the subject of this Course/ Workshop related to your present nature of work ?
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___________________________________________
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8.
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Has nominee attended any other similar training course ? If yes, give details.
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___________________________________________
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9.
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Details of Computer Courses completed if any
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___________________________________________
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Nominee's Signature
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Signature of sponsoring authority
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